P1606: CENTRAL VEIN CATHETERISATION IN ONCOHEMATOLOGICAL PATIENTS: COMPLICATION, ASSOCIATED WITH PROCEDURA AND CARE
Authors: N. Romanenko
Journal: HemaSphere (2022)

Background: The central vascular access needs to provide a large volume of infusion therapy, including transfusions of blood, long term infusion of immunotherapy and chemotherapy in oncohematological patients (OHP). Nevertheless, the procedure and care of central vein catheter (CVC) may lead to a number of serious complications Aims: To access the frequency of various complications associated with CVC in OHP Methods: There were studied the frequency of complications associated with procedure and care of CVC in OHP (n=3025) for the period of above 18 years (2003-2021 years). In the most cases CVC were performed by subclavian access: in the right subclavian vain (v.) were performed 2495 (82.5%) procedures, in the left subclavian v. – 521 (17.2%), and so in in the right internal jugular v. 9 cases (0.3%). After CVC procedure was X-ray control. The bacteriological and fungal analyses and so identification of microbial pathogen were done in every cases if it was suspected an infectious Results: The immediate hemorrhagic complications after procedure of CVC were found the most frequent. These were: 1) hematoma – in 121 cases (4.0%), 2) puncture of an artery – in 83 (2.7%), and one case of catheterization the right subclavian arteria, 3) bleeding from the catheter passage area – in 82 (2.7%), 4) clinically significant lymphorrhea – in 42 cases (1.4%). Delayed complication in generally connected with care or related to the course of the disease were little rear. So, the thrombotic complications included thrombophlebitis, infiltrate with thrombosis of subclavian vein and they were counted 79 cases (2.6%). A number of thrombotic complications were associated with bacterial infections. Besides we observed rarely such complications as pain, numbness, paresthesia of the upper limb in 50 patients (1.7%). As well as weakness, allergic Quincke’s edema, fainting or collapse associated with anesthesia were observed in 35 ones (1.2%). Among the dangerous clinically significant complications that required additional measures were pneumothorax (n=4; 0.13%) and pneumothorax with hemoptysis (n=2; 0.07%). The complications associated with bloodstream infection in the form of bacteremia or fungemia, which were observed by bacteriological culture, were detected in 74 (2.4%) patients. Positive bacterial cultures from venous blood were detected in 92 cases, and 12 blood probes of them had mixed infection (2 or 3 bacterial pathogens). Analysis of the different microorganisms indicated the prevalence of Gram-positive pathogens – 63.1% (n=58): the most part was Coagulase-negative Staphylococcus – 51.1% (n=47), S. aureus – 8.7% (n=8), Streptococcus viridance 1.1% (n=1), Enterococcus spp. – 1.1% (n=1) and Micrococcus spp. – 1.1% (n=1). Gram-negative microorganisms were detected in the whole group 29.4% (n=27) of cases: Escherichia coli – 15.2% (n=14) patients, Enterobacter spp. – 8.6% (n=8), Acinetobacter spp. – 1.1% (n=1), Pseudomonas aeruginosa – 2.2% (n=2), Neisseria spp. – 2.2% (n=2). Causative agents of fungal infections were found for 7.6% of patients (n=7). They included fungi of the genus Candida – 6.5% (C. albicans – 5.4% (n=5), C. crusei – 1.1% (n=1)) and Rhodotorula spp. – 1.1% (n=1). Summary/Conclusion: In was found the most of CVC’s complications were associated with hemorrhagic as hematoma (4.0%), puncture of an artery (2.7%), and bleeding from the catheter passage area (2.7%) and they were connected with technic of procedure and hemostasis disorders. Blood stream infections associated with CVC were caused by gram-positive microbes in general and dependent on care and neutropenia